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Deadly rampage: We have seen it before

The images were riveting: Residents shaken to the core in Charleston, S.C., holding hands and forming a circle of prayer down the street from what was another mass shooting in the U.S. It has happened before

The images were riveting in the early hours Thursday morning: Residents shaken to the core in Charleston, S.C., holding hands and forming a circle of prayer down the street from what was another mass shooting in the U.S.

It has happened before in a kindergarten class, a college campus, a movie theater, a McDonald's. The words resonate as places forever linked with the unspeakable: Sandy Hook, Columbine, Virginia Tech, Luby's.

And this time it was a humble church, the Emanuel African Methodist Episcopal Church, the oldest AME church in the South, where people had gathered for a prayer meeting Wednesday night.

"I do believe this was a hate crime," Police Chief Gregory Mullen said after confirming that nine people were dead.

"This is a tragedy that no community should have to experience," Mullen said. "It is senseless. It is unfathomable that someone would walk into a church when people are having a prayer meeting and take their lives."

Said Charleston's mayor, Joe Riley: "This is inexplicable. … It is the most intolerable and unbelievable act possible. The only reason someone could walk into church and shoot people praying is out of hate."

Since 2006, there have been more than 200 mass killings in the U.S. The FBI defines a mass killing as an incident with four or more victims.

A USA TODAY special report, Behind the Bloodshed, documented how mass killings occur about every two weeks. Public massacres such as the 2012 shooting at Sandy Hook Elementary School in Newtown, Conn., account for one in six mass killings.

The report also documented how the majority of mass killings are family-related. Seventy-seven percent of mass killings involve a gun, and nearly three out of four guns involved were handguns, USA TODAY found.

One of the most stunning revelations in the report: A mass killing often involves a failed safety net: protective orders that didn't work, gaps in the mental health system, lapses in immigration enforcement.

For communities reeling from tragedies it can be grueling to move forward. Support is the No. 1 priority, says Steven Dubovsky, a professor and chair of psychiatry and expert on post-traumatic stress at the University at Buffalo.

"The community must support one another and seek professional help," says Dubovsky, who interviewed survivors of the Columbine high school massacre. "Reliving what happened in a controlled, private manner will be helpful."

Figuring out how members of a community can heal knowing their town will forever be associated with a tragedy is another challenge. "If they can develop and convey a sense of unity ... they will be known as a community that transcended crisis, instead of a community that was destroyed by tragedy," Dubovsky says.

Here are some of the deadliest rampages in U.S. history:

• Dec. 14, 2012: Adam Lanza, 20, guns down 20 children and six adults at Sandy Hook Elementary School before killing himself.

• July 20, 2012: James Holmes allegedly guns down 12 people in an Aurora, Colo., movie theater. He is on trial.